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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Immunotherapy-induced Hepatotoxicity: A Review.

Teresa Da Cunha1, George Y Wu1, Haleh Vaziri1

  • 1Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA.

Journal of Clinical and Translational Hepatology
|November 16, 2022
PubMed
Summary

Immune checkpoint inhibitors (ICIs) enhance anti-cancer immunity but can cause liver damage (hepatotoxicity). Early recognition and management, guided by scoring systems like RUCAM, are crucial for patient outcomes.

Keywords:
HepatitisImmune checkpoint inhibitorsImmunotherapyLiver injury

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Area of Science:

  • Immunology
  • Oncology
  • Hepatology

Background:

  • Immune checkpoint inhibitors (ICIs) modulate T cell activity to enhance anti-cancer immune responses.
  • Increased use of ICIs for cancer treatment has led to a rise in reported immune-related adverse events, including hepatotoxicity.
  • Gastroenterologists and hepatologists require updated knowledge on diagnosing and managing ICI-induced liver injury.

Purpose of the Study:

  • To review the epidemiology, risk factors, clinical presentation, and diagnostic approaches for immunotherapy-induced hepatotoxicity.
  • To outline current management strategies for liver injury associated with immune checkpoint inhibitors.
  • To emphasize the importance of causality assessment tools like RUCAM in evaluating drug-induced liver injury.

Main Methods:

  • Literature review of recent studies on immunotherapy-induced hepatotoxicity.
  • Emphasis on studies utilizing the Roussel Uclaf Causality Assessment Method (RUCAM) for causality assessment.
  • Synthesis of information regarding risk factors, clinical manifestations, and diagnostic criteria.

Main Results:

  • Hepatotoxicity is a significant adverse event associated with ICIs, affecting various organs with the liver being commonly involved.
  • RUCAM is a critical tool for assessing causality, identifying risk factors, and guiding management decisions in potential ICI-induced liver injury.
  • Management involves prompt recognition, cessation of ICI, and appropriate medical intervention.

Conclusions:

  • ICI-induced hepatotoxicity necessitates specialized knowledge for timely diagnosis and effective management.
  • Utilizing structured assessment tools like RUCAM is vital for accurate diagnosis and treatment planning.
  • Continued research and clinical vigilance are essential to optimize patient care in the era of cancer immunotherapy.